GRAND TETON CHILD NEUROLOGY


Address: 1975 Martha Ave, Idaho Falls, ID 83404-7580
Phone: 2085294300

GRAND TETON CHILD NEUROLOGY (NPI# 1639322258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1639322258
Entity Type Organization
Organization Name GRAND TETON CHILD NEUROLOGY
Practice Address 1975 Martha Ave
Idaho Falls
ID 83404-7580
Practice Telephone 2085294300
Practice Fax Number 2085291627
Mailing Telephone 2085294300
Mailing Fax Number 2085291627
Enumeration Date 2008-10-28
Last Update Date 2008-10-28
Authorized Official Name DR. PETER W CASTELLANOS (NEUROLOGIST)
Authorized Official Telephone 2085294300
Authorized Official Credential MD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 251S00000X Community/Behavioral Health Agencies

Other Provider Identifier

State Issuer Identifier Type Code
ID BLUE CROSS OF IDAHO 77234 01
ID 807968700 05

Office Location

Street Address 1975 MARTHA AVE
City IDAHO FALLS
State ID
Zip Code 83404-7580

Providers in the same location

NPI Name Taxonomy Address Enumeration
1558457572 Stephen R Marano Neurological Surgery 1975 Martha Ave, Ste A, Idaho Falls, ID 83404-7580 2006-10-05
1669785192 Wind River Pain Management Pllc Anesthesiology 1975 Martha Ave, Suite B, Idaho Falls, ID 83404-7580 2010-07-26
1285959908 Idaho Psychiatric Institute Occupational Therapist 1975 Martha Ave, Idaho Falls, ID 83404-7580 2010-04-06
1811211527 Missy Renee Sturk Occupational Therapist 1975 Martha Ave, Idaho Falls, ID 83404-7580 2010-03-24
1881823979 Brandon M Buhler Marriage & Family Therapist 1975 Martha Ave, Idaho Falls, ID 83404-7580 2009-07-09
1518110972 Jessica C. Carlson Counselor 1975 Martha Ave, Idaho Falls, ID 83404-7580 2008-10-29
1568540706 Steven V Klippert Anesthesiology 1975 Martha Ave, Ste. B, Idaho Falls, ID 83404-7580 2006-11-02
1497838478 James Lee Cook Neurological Surgery 1975 Martha Ave, Ste A, Idaho Falls, ID 83404-7580 2006-10-23

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NPI Name Taxonomy Address Enumeration
1437750809 Joshua M Murphy Dentist 1580 Elk Creek Dr., Idaho Falls, ID 83404 2020-11-03
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1942863600 Muhammad Arslan Khan Student in an Organized Health Care Education/Training Program 2860 Channing Way Suite 214, Idaho Falls, ID 83404 2019-04-18
1942771043 Physician's Choice Cardiology, Pllc Internal Medicine 3302 Valencia, Suite 201, Idaho Falls, ID 83404 2018-12-16
1609358761 Cardiac Cath Lab of Idaho Falls Internal Medicine 3311 Valencia Drive, Idaho Falls, ID 83404 2018-09-05
1083196380 Hannah Golden Occupational Therapist 1460 Elk Creek, Idaho Falls, ID 83404 2018-09-04
1316423049 Lindsay Sessions Speech-Language Pathologist 2210 Niagara St, Idaho Falls, ID 83404 2018-07-16
1720574023 Bmh, Inc. Anesthesiology 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 2018-07-10
1093237935 Jason Earl Bailey Contractor 3100 S Woodruff Ave., Idaho Falls, ID 83404 2017-07-12
1235682121 Mountain Falls Quick Care Clinic/Center 1995 E 17th St #1, Idaho Falls, ID 83404 2016-07-27
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Taxonomy Information

Taxonomy Code 251S00000X
Grouping Agencies
Classification Community/Behavioral Health

Taxonomy Definition

A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1023634672 Padron Counseling Services, LLC Community/Behavioral Health 522 Lomax St, Idaho Falls, ID 83401-2634 2020-06-19
1841830908 Badger Inc Community/Behavioral Health 1650 N Holmes Ave, Idaho Falls, ID 83401-3200 2020-01-07
1275065807 Jjst Enterprises Corp Community/Behavioral Health 1920 E 17th St Ste 213, Idaho Falls, ID 83404-8036 2017-04-02
1689068454 Addiction Treatment Centers of Idaho Community/Behavioral Health 211 S. Woodruff Avenue, Idaho Falls, ID 83401 2015-03-19
1851706626 Snake River Community Supported Living Community/Behavioral Health 557 S Woodruff Ave, Idaho Falls, ID 83401-5200 2014-06-30
1134556970 Eastern Idaho Community Action Partnership Community/Behavioral Health 935 E Lincoln Rd, Idaho Falls, ID 83401-2119 2013-10-10
1750727459 D7 Treatment Community/Behavioral Health 254 E St Ste B, Idaho Falls, ID 83402-3527 2013-05-21
1669815726 Proventures LLC Community/Behavioral Health 1422 E 17th St, Suite A, Idaho Falls, ID 83404-6285 2013-04-09
1740580026 Vista Health Center, LLC Community/Behavioral Health 452 D St, Idaho Falls, ID 83402-3531 2010-11-02
1689846362 The Idaho Children's Rehabilitation Center Community/Behavioral Health 1975 Martha Avenue, Idaho Falls, ID 83404-7533 2008-04-02
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Competitor

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City IDAHO FALLS
Zip Code 83404

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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